Multi-informant evaluation of students' psychosocial status through SDQ in a national Greek sample
Introduction
The mental health of children and adolescents is of prime importance worldwide. The use of epidemiological studies has been reported as necessary for the accurate assessement trends in population prevalence (Achenbach et al., 2008. Braddick, Carral, Jenkins, & Jane-Llopis, 2009. Goodman, 2001). To our knowledge, in Greece there are few epidemilogical studies assessing trends and giving information on children's/adolescents' mental health (Giannakopoulos et al., 2013; Kolaitis, Fyssas, & Tsiantis, 2009), resulting in inadequate data, both in terms of quality and quantity. In addition, the absence of administrative process data from the health system, the malfunctioning of health facilities at primary care and specialist care levels, as well as the absence of school psychology services, form the main barriers in methodically gathering data overtime. Moreover, the drastic funding cuts to Greek child and adolescent mental health services since 2007 as a result of the financial crisis has meant a reduction in care and treatment services (Kolaitis et al., 2009).
The present paper presents data from a European funded program regarding the screening of primary and secondary students using the Strengths and Difficulties Questionnaire (SDQ). This project is part of a larger national four-year pilot programme implementing psychological services to public schools that have at least 30% migrant students (Diapolis Programme, 2010-2013). The aims of the national program were, among others, the development of a pilot school support system with specialized psychological support services for students and their families, and the implementation of short-term multilevel prevention and intervention initiatives targeting all interested groups (students, teachers, parents). Part of the needs assessment stage was the administration of SDQ to all participant groups.
In many countries, social services and educational authorities have promoted the use of strengths-based measures as part of the assessment process in schools, social services, and child and adolescent mental health agencies (Sointu, Savolainen, & Lappalainen, 2012). The SDQ is one of the most common screening tools used in clinical and educational settings for the assessment of children's psychosocial status (Chiorri, Hall, Casely-Hayford, & Malmberg, 2016). Multiple perspective assessment is valuable since it is grounded on the fact that the recognition of psychosocial problems tends to be situational and highly determined by children's relationships and informants' different mind-sets for judging and reporting child behaviour (Boman et al., 2016). There appears to be a partial conflicting correlation between teachers'and parents'SDQ ratings, highly and extensively searched in the literature (e.g. see De Los Reyes & Kazdin, 2005 for a theoretical model interpreting informant discrepancies). The parent and teacher reports are more often used in research, even though there is evidence to suggest that in the case of emotional difficulties self-report information is just as useful as teacher data, but less useful than parent data.
Internationally, there is conflicting evidence regarding the factor stucture of the SDQ (Boman et al., 2016; McCrory & Layte, 2012), as well as the inter-rater reliability of the instrument (Achenbach et al., 2008). Previous research studies conducted in diverse cultural contexts generally provided support for the hypothesised five-factor structure of the SDQ (Bøe, Hysing, Skogen, & Breivik, 2016, Giannakopoulos et al., 2010. Hill & Hughes, 2007. Ruchkin, Koposov, & Schwab-Stone, 2007. Vogels, Crone, Hoekstra, & Reijneveld, 2009), whereas others suggested that the SDQ does not have a very “clean” factor structure (Mellor & Stokes, 2007. Ronning, Handergaard, Sourander, & Morch, 2004). Alternative theoretically justifiable models have been validated elsewhere in the literature. Consistent with Goodman's original conceptualisation of the SDQ, Yao et al. (2009) found that a hierarchical model with a total difficulties factor underlying the four problem scales provided acceptable model fit among adolescents. Other investigators have tested a model where emotional problems and peer problems are replaced by an internalising problems factor, and conduct problems and hyperactivity-inatention scales with an externalising problems factor, whilst still retaining a separate prosocial behaviour factor. This three-factor model provided acceptable model fit for children in Italy (Di Riso et al., 2010), and in Belgium (van Leeuwen, Meerschaert, Bosmans, De Medts, & Braet, 2006). In the UK, Goodman, Lamping, and Ploubidis (2010) provided little support for replacing the scales with internalising and externalising factors. Instead, they found that a hierarchical model with higher-order internalising and externalising factors (and a separate prosocial behaviour factor) achieved acceptable model fit indices for the self-report versions of the scale. Finally, the evidence is also conflicting regarding the migrant students' risk of mental health problems (Boman et al., 2016). In Greece, adolescents' emotional and behavioural problems were documented by Giannakopoulos et al. (2010) and Giannakopoulos et al. (2013), based on a representative nationwide sample of 1.194 adolescents. Specifically, in the first study, SDQ was completed by adolescents, supporting the five-factor structure of the instrument; in the second study, the completion of SDQ by both adolescents and parents provided evidence of the psychometric characteristics of SDQ. Further, using the same sample, Giannakopoulos, Mihas, Dimitrakaki, and Tountas (2009), documented a series of family factors as potential determinants of adolescent mental health status.
This paper builds on former national and international studies investigating psychometric characteristics of the SDQ and aims: a) to provide an investigation of the factor structure of the Greek parent, teacher, and student versions of the SDQ, and b) to examine psychosocial functioning of a non-clinical student sample through multi-informant evaluation, as well as potential differences as a function of student gender, age, and immigration background. The data was collected around a time of wider recognition of the global economic downturn hitting Greece. Although the present study did not address the socio-economic situation of the families, we believe that this is a serious attempt to map out the psychosocial well being of school students through a multi-informant approach.
Section snippets
Participants and procedure
The study instruments were administered to a national sample of 6290 students, aged 11 to 15 years, attending 80 public schools in nine regions all over Greece. Completed questionnaires were returned by 5477 students, yielding a response rate of 87.1%, and 3570 parents (56.8%). Teacher data were available for 5037 students (80.0%). To assess non-response bias, we compared key demographic characteristics of respondents and non-respondents using Student's t-test and Chi square tests. There were
Factor structure of the SDQ
Model fit indices indicated that the originally proposed correlated 5-factor model demonstrated the best fit to the data for all three informants, as well as an acceptable overall fit (Table 1). Factor loadings for the five-factor model of the student version were found to be greater than 0.40 with the exception of item 7 on conduct problems (“I usually do as I am told “), which had a low loading of 0.15 (Table 2). This also partially explains the low reliability of this factor, and although
Discussion
Despite public policy and increased awareness that the assessment of children's and adolescents' psychosocial status is imperative, in Greece there is no support system offering psychological services to the school community (Kolaitis et al., 2009). As such, the purpose of this study was to investigate the structural validity and reliability evidence for SDQ as an early detection instrument, using a large national, geographically diverse school population sample across three informants The
Implications of practice
The study will help child and adolescent education and health professionals in problem perception and awareness of unmet needs for professional care and school psychological interventions, especially at a time when funding cuts have seriously affected youth mental health services and family functioning. The task of students' mental health evaluation and management should be incorporated into the school process for the prevention/promotion of students' psychosocial well being, based on the
Impact and implications of practice
The present study suggests that Strengths and Difficulties questionnaire is a valid and reliable psychometric test for the screening of students' psychosocial functioning in school communities. Parents, teachers and students can identify areas of concern regarding young peoples' mental health issues leading to effective community interventions. The results suggest that there are gender and ethnic origin differences across informants that could contribute significantly to youth mental health
Acknowledgement
The study is supported by National and European Funding. The authors have declared that they have no competing or potential conflicts of interest.
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